The bullet casings from the ammunition that killed UnitedHealthcare CEO Brian Thompson reportedly had three words written on them: “Deny”, “Defend” and “Depose.” These words allude to the strategy that some attorneys and critics have used to describe the tactics used by health insurance companies to deny making payment on claims — and the most recent available data suggests that UHC is perhaps the country’s worst offender.
When it comes to denying claims, multiple reports suggest that UHC, which is the country’s largest health insurer and serves some 50 million people, is an industry leader, with a rate nearly double the industry average. A recent Senate report slammed the company for denying nursing care to patients recovering from falls and strokes on its Medicare Advantage plans, and it currently faces a class action lawsuit for its use of AI algorithms to automatically refuse payment.
The insurance giant’s tactics have frustrated patients and healthcare providers alike. A major protest at the company’s subsidiary Optum’s headquarters in Minnesota in July attracted roughly 50 demonstrators, 11 of whom were arrested. Disputes with hospital systems over UHC’s claim denials have led to some deciding not to accept its insurance at all.
Gauging an exact number of claim denials is tricky, as there’s no central repository of this data, insurance insights firm ValuePenguin told Forbes. But according to one of the firm’s reports on insurance claim denial rates, UHC has the highest instance of denials out of all major providers, refusing an estimated one-third of claims submitted. The insurer did not respond to a comment request.
UnitedHealthcare also has the largest market share of health insurance policies, with roughly $215 billion in revenue. ValuePenguin said that based on current insurance plan costs, UHC offers the most expensive premiums in the nation compared to other providers. For example, a middle-tier plan with UHC would cost a 40-year-old person $631 per month, whereas the national average would amount to an estimated $621 per month.
The shooting has reignited a national conversation about America’s for-profit healthcare sector and many people’s inability to afford treatments and medication. HealthCare.gov issuers denied a total of 17% of claims in 2021, with some issuers’ denial rates reaching 49%, according to a 2023 report by health researcher KFF. In a 2023 survey of consumers’ experience with their health coverage, KFF found that nearly half of adults who had insurance problems were unable to satisfactorily resolve them, with 15% saying they experienced a decline in their health and 28% saying they paid more than they expected.
A still-unidentified man shot and killed Thompson as he was on his way to a Manhattan investor meeting for parent company UnitedHealth Group around 6:45 a.m. on Wednesday. In the hours after, anger and frustration over insurance denials and medical costs bubbled up online and in conversations. “When you shoot one man in the street, it’s murder. When you kill thousands by taking away their ability to get treatment you’re an entrepreneur,” one angry poster wrote on X, formerly Twitter.
Thompson’s wife Paulette told NBC News on Wednesday that she was aware he had received some threats. “Basically, I don’t know, a lack of coverage?” she said. “I don’t know details. I just know that he said there were some people that had been threatening him.”
At the Forbes Healthcare Summit in New York on Wednesday, attendee Michael Patton, founder and president of Excel Health Plans, said his initial reaction was that the shooting may have been related to someone whose claim had been denied, given the anger such an experience can cause. Police are still searching for the suspect, and his motivation remains a matter of conjecture.
The company is facing multiple lawsuits over its denials. In November of last year, the estates of two deceased Medicare Advantage patients sued UHC, alleging that their claims for care were denied using an AI model with a “90% error rate.” (UnitedHealth had argued that the lawsuit should be dismissed because patients didn’t complete their appeals.) In October 2024, the Senate Subcommittee on Investigations published a report that found the company was using algorithms to deny claims and “knew from testing that at least one of these automation technologies resulted in an increase in the share of those requests being denied.”
UnitedHealthcare’s practices have also been a source of tension with hospitals and healthcare systems in recent years. Trinity Health of New England, for example, briefly dropped UHC earlier this year over a number of issues, including the fact that it initially denied over 10% of its Medicare Advantage claims. The parties came to an agreement in August, but it’s hardly the only system that’s had issues with the insurer. According to Becker’s Hospital Review, six health systems dropped the insurer in 2024.
After months of negotiation with the University of Florida Health System around renewing their contract, the two entities couldn’t come to an agreement, and UHC dropped the health system from its coverage in September. UF said in a statement that the insurer wanted to pay below market rates for healthcare services (UHC said its rates were “market-competitive”), and that “lengthy prior authorization processes, complicated billing and coding requirements, and claim denials/payment delays have led to reductions” in payments from UHC.
Delays and denials from UHC also frustrated its relationship with Duke Health, whose CEO said in an interview earlier this year that the insurer “has been 57% slower to pay claims than our other payers and takes over 60 days to respond to claims they deny.”
UnitedHealthcare announced a new policy, effective December 1, by which it may deny charges for inpatient or outpatient services that it considers “routine” — which would give the insurer more opportunity to issue denials around specific line-items, according to healthcare attorneys at Davis Wright Tremaine.
“Healthcare should be easier for people,” Johnson, 50, said at an investor meeting last year. He became CEO of UHC in April 2021, and received total compensation of $10.2 million, according to the company’s proxy statement. Johnson joined UnitedHealth Group in 2004, and previously served as head of government programs, including Medicare.
UnitedHealthcare wasn’t the only insurer facing consumers’ wrath this week. Anthem Blue Cross Blue Shield said that it would deny claims for anesthesia that lasted longer than specific time limits it set for surgeries starting in February. Following an outcry, the insurer said that it would not go forward with its policy change.
Sarah Emerson contributed reporting.
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